{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T21:02:52Z","timestamp":1792270972073,"version":"4.4.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T00:00:00Z","timestamp":1738800000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T00:00:00Z","timestamp":1738800000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001635","name":"University of Limerick","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001635","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ir J Med Sci"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The prevalence of peripheral arterial disease (PAD) is increasing globally. An increase in PAD in an ageing population inevitably results in an increase in incidence of Chronic Limb Threatening Ischemia (CLTI). Loss of a limb is a life-changing event with immeasurable cost to the individual, while the potential financial benefit of saving a limb is not well documented.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Aims<\/jats:title>\n            <jats:p>The focus of this study was to estimate the cost associated with surgical interventions used in the treatment of CLTI compared with amputation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The cost to treat a CLTI diagnosis in 124 patients was analysed in an acute tertiary referral hospital over a 13-month study period. The analysis included staffing, medical devices used, number of blood components used and the length of stay. Statistical methods included descriptive statistical data and the Mann\u2013Whitney U test.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The median cost, associated with length of stay, post-amputation and post-revascularisation (hybrid) was \u20ac61,313 [IQR\u2009=\u2009\u20ac44,417,\u00a0\u20ac83,331] and \u20ac46,573 [IQR\u2009=\u2009\u20ac25,687, \u20ac58,554] respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001.<\/jats:p>\n            <jats:p>The total median cost for length of stay for amputees in an acute hospital, rehabilitation and a prosthetic limb was \u20ac88,820 [IQR\u2009=\u2009\u20ac74,486, \u20ac110,248].<\/jats:p>\n            <jats:p>The median surgical cost of an amputation was \u20ac2,064 [IQR\u2009=\u2009\u20ac1,342, \u20ac2,866], whilst the median surgical cost of a revascularisation procedure (hybrid) was \u20ac5,966 [IQR\u2009=\u2009\u20ac4,380, \u20ac7,723], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, inclusive of total blood components transfused.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Revascularisation surgical interventions are more expensive than amputation, however, the length of stay, rehabilitation and prosthetic limb costs, for a patient undergoing a major limb amputation, is significantly more costly.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11845-025-03885-9","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T06:13:00Z","timestamp":1738822380000},"page":"663-673","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Cost analysis of limb salvage: comparing limb revascularisation and amputation in patients with Chronic Limb-Threatening Ischaemia (CLTI) at University Hospital Limerick"],"prefix":"10.1007","volume":"194","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4363-8642","authenticated-orcid":false,"given":"Anne Marie","family":"Toomey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Leahy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Purtill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norma","family":"O\u2019Brien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emer","family":"O\u2019Donovan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mekki","family":"Medani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Moloney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eamon G.","family":"Kavanagh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,6]]},"reference":[{"issue":"1","key":"3885_CR1","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.ejvs.2019.05.006","volume":"58","author":"M Conte","year":"2019","unstructured":"Conte M, Bradbury A, Kolh P (2019) \u2018Global vascular guidelines on the management of chronic limb ischemia\u2019, clinical practice guideline document. European Journal of Vascular Endovascular Surgery 58(1):S1\u2013S109>E33. https:\/\/doi.org\/10.1016\/j.ejvs.2019.05.006","journal-title":"European Journal of Vascular Endovascular Surgery"},{"key":"3885_CR2","doi-asserted-by":"publisher","unstructured":"Hart, O., Xue, N., Davis-Havill, B., et al. (2022) The incidence of chronic limb threatening ischemia in the midland region of New Zealand over a 12-year period. Journal of Clinical Medicine 11(12):3303.  https:\/\/doi.org\/10.3390\/jcm11123303","DOI":"10.3390\/jcm11123303"},{"key":"3885_CR3","doi-asserted-by":"publisher","unstructured":"Aziz, H., Branco, B.C., Braun, J.et al. (2015) The influence of do not resuscitate status on the outcomes of patients undergoing emergency vascular operations. J of Vascular Sur 61(6):1538\u20131542.  https:\/\/doi.org\/10.1016\/j.jvs.2014.11.087","DOI":"10.1016\/j.jvs.2014.11.087"},{"issue":"7","key":"3885_CR4","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.avsg.2015.05.014","volume":"29","author":"JJ Siracuse","year":"2015","unstructured":"Siracuse JJ, Jones DW, Meltzer EC et al (2015) \u2018Impact of \u201cdo not resuscitate\u201d status on the outcome of major vascular surgical procedures. Annals of Vascular Sur 29(7):1339\u20131345. https:\/\/doi.org\/10.1016\/j.avsg.2015.05.014","journal-title":"Annals of Vascular Sur"},{"issue":"5","key":"3885_CR5","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1213\/01.ANE.0000147705.94738.31","volume":"100","author":"B Subramaniam","year":"2005","unstructured":"Subramaniam B, Pomposelli F, Talmor D, Park KW (2005) \u2018Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics. Anesth Analg 100(5):1241\u20131247. https:\/\/doi.org\/10.1213\/01.ANE.0000147705.94738.31","journal-title":"Anesth Analg"},{"key":"3885_CR6","doi-asserted-by":"publisher","unstructured":"Fortington, L.V., Geertzen, J.H., van Netten, J.J. et al. (2013) Short and long term mortality rates after a lower limb amputation. Euro  J  Vascular Endovascular Sur 46(1):124\u2013131.  https:\/\/doi.org\/10.1016\/j.ejvs.2013.03.024","DOI":"10.1016\/j.ejvs.2013.03.024"},{"key":"3885_CR7","doi-asserted-by":"publisher","unstructured":"Menard, M.T., Farber, A., Assmann, S.F. et al (2016) \u2018Design and rationale of the best endovascular versus best surgical therapy for patients with critical limb ischemia (BEST\u2010CLI) Trial. J Am Heart Asso 5(7). https:\/\/doi.org\/10.1161\/jaha.116.003219.","DOI":"10.1161\/jaha.116.003219"},{"key":"3885_CR8","doi-asserted-by":"publisher","unstructured":"Bradbury A.W., Adam D.J., Bell J. et al (2010) Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: Analysis of amputation free and overall survival by treatment received.  J Vascular Sur, 51(5). https:\/\/doi.org\/10.1016\/j.jvs.2010.01.074","DOI":"10.1016\/j.jvs.2010.01.074"},{"issue":"12","key":"3885_CR9","doi-asserted-by":"publisher","first-page":"1885","DOI":"10.1161\/circresaha.121.318261","volume":"128","author":"JA Beckman","year":"2021","unstructured":"Beckman JA, Schneider PA, Conte MS (2021) Advances in revascularization for peripheral artery disease: Revascularization in PAD. Circu Res 128(12):1885\u20131912. https:\/\/doi.org\/10.1161\/circresaha.121.318261","journal-title":"Circu Res"},{"key":"3885_CR10","unstructured":"HSE (n.d.), \u2018UL Hospitals Group: Facts and Figures\u2019 available: https:\/\/healthservice.hse.ie\/healthcare-delivery\/ul-hospitals-group\/about-ul-hospitals-group\/ul-hospital-group-facts-and-figures.html [accessed: 12 Aug 2023]"},{"key":"3885_CR11","unstructured":"Department of Health, The HRB national drugs library - drugs and alcohol (2022), \u2018Health in Ireland, Key Trends in 2022\u2019 available at: https:\/\/www.drugsandalcohol.ie\/37620\/1\/Health%20in%20Ireland%20Key%20Trends%202022.pdf [accessed: 12 Aug 2023]"},{"key":"3885_CR12","unstructured":"HSE (2022), \u2018Health Sector - Consolidated Salary Scales in Accordance with The Fempi Acts, The Public Service Agreements and The Public Service Pay and Pensions Act 2017\u2019, available: https:\/\/assets.hse.ie\/media\/documents\/Pay_scales_for_2.2.22_and_1.10.22_adjustments_V2.pdf [accessed: 29 Jul 2023]"},{"key":"3885_CR13","unstructured":"Health Pricing Office (2022), \u2018ABF 2022 admitted patient price list DRG prices for inpatients and day cases 2022\u2019, available: https:\/\/www.hpo.ie\/abf\/ABF2022AdmitedPatientPriceList.pdf [accessed: 29 Jul 2023]"},{"key":"3885_CR14","unstructured":"Health Pricing Office (2023), \u2018ABF 2023 admitted patient price list DRG prices for inpatients and day cases 2023\u2019, available: http:\/\/www.hpo.ie\/abf\/ABF2023AdmittedPatientPriceListv1.pdf [accessed: 29 Jul 2023]"},{"key":"3885_CR15","unstructured":"Health Pricing Office (2020), \u2018ABF 2020 Admitted Patient Price List DRG Prices for Inpatients and Daycases 2020\u2019, available at: https:\/\/www.hpo.ie\/abf\/ABF2020AdmittedPatientPriceList.pdf [accessed: 31 Oct. 2021]."},{"key":"3885_CR16","unstructured":"Department of Health and Children (2023), \u2018Casemix measurement in Irish Hospitals? a broad outline of the main features \/ Casemix Unit, available: https:\/\/www.lenus.ie\/bitstream\/handle\/10147\/46324\/1179.pdf;jsessionid=BBE8022AE8ACC698960ADD53450622A3?sequence=1 [accessed: 30 Jul 2023]"},{"key":"3885_CR17","unstructured":"Tenny, S. and Abdelgawad, I. (2022) \u2019Statistical significance\u2019 [online] Nih.gov. available at: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459346\/ [accessed: 21 Jan 2024]"},{"key":"3885_CR18","unstructured":"IBM Corp (2021) IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp"},{"issue":"4","key":"3885_CR19","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1177\/1526602818774786","volume":"25","author":"L Tang","year":"2018","unstructured":"Tang L et al (2018) Cost analysis of initial treatment with endovascular revascularization, open surgery, or primary major amputation in patients with peripheral artery disease. J Endo Therapy: An Afficial J Inter Soc Endo Spec 25(4):504\u2013511. https:\/\/doi.org\/10.1177\/1526602818774786","journal-title":"J Endo Therapy: An Afficial J Inter Soc Endo Spec"},{"key":"3885_CR20","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.avsg.2022.04.036","volume":"85","author":"LL Shan","year":"2022","unstructured":"Shan LL et al (2022) A systematic review of cost-utility analyses in chronic limb-threatening ischemia. Anns Vascular Sur 85:9\u201321. https:\/\/doi.org\/10.1016\/j.avsg.2022.04.036","journal-title":"Anns Vascular Sur"},{"key":"3885_CR21","unstructured":"Independent Hospital Pricing Authority (2019) \u2018Australian Refined Diagnosis Related Groups Version 10.0 Final Report\u2019 available: https:\/\/www.ihacpa.gov.au\/sites\/default\/files\/2022-08\/AR-DRG%20Version%2010.0%20Final%20Report_0.pdf [accessed: 29 Jul 2023]"}],"container-title":["Irish Journal of Medical Science (1971 -)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11845-025-03885-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11845-025-03885-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11845-025-03885-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T06:14:44Z","timestamp":1745561684000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11845-025-03885-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,6]]},"references-count":21,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["3885"],"URL":"https:\/\/doi.org\/10.1007\/s11845-025-03885-9","relation":{},"ISSN":["0021-1265","1863-4362"],"issn-type":[{"value":"0021-1265","type":"print"},{"value":"1863-4362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,6]]},"assertion":[{"value":"12 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was obtained from the Quality &  Safety Department, the UL Hospitals Group and is  compliant with ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}